【摘要】：目的：觀察左西孟旦注射液對急性失代償心力衰竭(Acute decompensated heart failure, ADHF)患者的心率變異性的影響。 方法：選擇了延邊大學(xué)附屬醫(yī)院2012年6月～2013年1月之間治療的急性心力衰竭的患者60例,隨機的分成觀察組與對照組,各為30例,均行基礎(chǔ)抗心衰治療；觀察組在基礎(chǔ)抗心衰治療上持續(xù)微泵注射左西孟旦注射液,療程為一周,在治療前后均行常規(guī)、生化、心臟彩超及動態(tài)超聲心動圖檢查,并記錄各項檢查結(jié)果,通過系統(tǒng)分析得出心功能心率變異性(Heart rate variability HRV)的時域、頻域分析指標(biāo),比較對照組與觀察組治療前后自主神經(jīng)功能及心臟功能的改善情況。 結(jié)果： (1).其中觀察組與對照組,它們在患者的年齡、性別、基礎(chǔ)心臟病及心功能分級等資料比較上,均差異無統(tǒng)計學(xué)意義(P0.05)； (2).觀察組與對照組用藥前后HRV各參數(shù)與治療前比較,對照組治療后心率(Heart rate, HR)明顯降低(P0.05),24h內(nèi)正常的RR間期標(biāo)準(zhǔn)差(SDNN)、RR間期平均值的標(biāo)準(zhǔn)差(SDANN)、相鄰RR間期差值均方根(RMSSD)、相鄰RR間期差值大于50ms百分比(PNN50)、RR間期的標(biāo)準(zhǔn)差的平均值(SDNNI)、低頻功率(LF)、高頻功率(HF)均升高,其中LF、HF升高具有統(tǒng)計學(xué)意義(P0.05);觀察組在治療后,其中HR明顯降低(P0.05),SDNN、SDANN、RMSSD、SDNNI、LF、HF均明顯升高(P0.05)。對照組與觀察組治療后HR、SDNN、SDANN、RMSSD、SDNNI、LF、HF的參數(shù)比較,差異均具有統(tǒng)計學(xué)意義(P0.05)。 (3).觀察組和對照組在治療前心功能射血分?jǐn)?shù)及每搏輸出量比較,無統(tǒng)計學(xué)意義(P0.05),治療后觀察組與對照組均有所改善,觀察組改善更加顯著,(P0.05)。(4)兩組在治療前后對患者血常規(guī)、血糖、血脂、肝功、腎功等變化無顯著差異(P0.05)。 結(jié)論：左西孟旦對急性心力衰竭有顯著的治療作用,改善心率變異性是其機制之一。
[Abstract]:Aim: to observe the effect of levosimendan injection on heart rate variability in patients with acute decompensated heart failure (Acute decompensated heart failure, ADHF). Methods: sixty patients with acute heart failure treated in Yanbian University affiliated Hospital from June 2012 to January 2013 were randomly divided into observation group and control group, 30 cases in each group. All patients were treated with basic anti-heart failure therapy. The observation group received continuous micropump injection of levosimendan injection on basic anti-heart failure therapy for a course of one week. Routine, biochemical, cardiac color Doppler and dynamic echocardiography were performed before and after treatment, and the results were recorded. The time-domain and frequency-domain indexes of heart rate variability (Heart rate variability HRV) were obtained by systematic analysis, and the improvement of autonomic nerve function and cardiac function before and after treatment were compared between the control group and the observation group. Results: (1). There was no significant difference between the observation group and the control group in age, sex, basic heart disease and cardiac function grading (P0.05); (2). The parameters of HRV before and after treatment in the observation group and the control group were compared with those in the control group before and after treatment. Heart rate (Heart rate, HR) decreased significantly after treatment in the control group (P0.05) within 24 hours, the normal RR interval standard deviation (SDNN) / RR interval) standard deviation (SDANN), adjacent RR interval difference value (RMS) (RMSSD), adjacent RR interval difference was greater than 50ms percentage (PNN50) / RR interval standard deviation. The mean (SDNNI), low frequency power (LF), high frequency power (HF) all increased. The increase of LF,HF was statistically significant (P0.05); in the observation group, HR was significantly decreased (P0.05). The parameters of HR,SDNN,SDANN,RMSSD,SDNNI,LF,HF in control group and observation group were significantly different after treatment (P0.05). (3). There was no significant difference in ejection fraction and stroke output before treatment between the observation group and the control group (P0.05). After treatment, both the observation group and the control group improved, and the improvement in the observation group was more significant (P0.05). (4). There was no significant difference in blood lipid, liver function and renal function (P0.05). Conclusion: levosimendan has a significant therapeutic effect on acute heart failure, and improving heart rate variability is one of its mechanisms.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R541.6

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